Records Request

For Release of Records

To request your medical records, please complete the AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION form requesting your medical records. Click here to access the form for all Middle Tennessee Offices. Click here to access the form for Chattanooga.

The release must be completed and signed by you, parent/guardian, conservator or other legal representative of the individual whose records are being requested. If you are a legal representative, the legal document appointing you must also be presented with your request, unless it is on file with the agency.

Requests for medical records can be submitted at any MHC office. You may also request records by mail or fax by sending the completed release, a copy of your photo identification and what information you are specifically requesting to: